Eikelboom J W, Lonn E, Genest J, Hankey G, Yusuf S
Preventive Cardiology and Therapeutics Program, McMaster University, Hamilton, Ontario, Canada.
Ann Intern Med. 1999 Sep 7;131(5):363-75. doi: 10.7326/0003-4819-131-5-199909070-00008.
To review epidemiologic studies on the association between homocyst(e)ine level and risk for cardiovascular disease and the potential benefits of homocysteine-decreasing therapies.
Computerized and manual searches of the literature on total homocysteine levels and cardiovascular disease.
Prospective studies and major retrospective epidemiologic studies evaluating the association between homocyst(e)ine levels and cardiovascular disease and the association between blood levels or dietary intake of folate, vitamin B6, and vitamin B12 and cardiovascular disease.
Relevant data on patient population, plasma homocyst(e)ine levels, duration of follow-up, and main results were extracted from studies that met the inclusion criteria.
The designs and results of studies included in this review are summarized. A formal meta-analysis was not performed because the studies were heterogeneous in method and design.
Results of epidemiologic studies suggest that moderately elevated plasma or serum homocyst(e)ine levels are prevalent in the general population and are associated with an increased risk for cardiovascular disease, independent of classic cardiovascular risk factors. Simple, inexpensive, nontoxic therapy with folic acid, vitamin B6, and vitamin B12 reduces plasma homocyst(e)ine levels. Although the association between homocyst(e)ine levels and cardiovascular disease is generally strong and biologically plausible, the data from the prospective studies are less consistent. In addition, epidemiologic observations of an association between hyperhomocyst(e)inemia and cardiovascular risk do not prove the existence of a causal relation. Therefore, the effectiveness of folate, vitamin B6, and vitamin B12 in reducing cardiovascular morbidity and mortality requires rigorous testing in randomized clinical trials. Several such trials are under way; their results may greatly affect cardiovascular morbidity and mortality, given the simplicity and low cost of vitamin therapy.
综述关于同型半胱氨酸水平与心血管疾病风险之间关联以及降低同型半胱氨酸疗法潜在益处的流行病学研究。
通过计算机和手工检索有关总同型半胱氨酸水平与心血管疾病的文献。
前瞻性研究以及主要的回顾性流行病学研究，评估同型半胱氨酸水平与心血管疾病之间的关联，以及叶酸、维生素B6和维生素B12的血液水平或饮食摄入量与心血管疾病之间的关联。
从符合纳入标准的研究中提取有关患者人群、血浆同型半胱氨酸水平、随访时间和主要结果的相关数据。
总结了本综述中纳入研究的设计和结果。由于研究在方法和设计上存在异质性，未进行正式的荟萃分析。
流行病学研究结果表明，一般人群中血浆或血清同型半胱氨酸水平中度升高较为普遍，且与心血管疾病风险增加相关，独立于经典的心血管危险因素。使用叶酸、维生素B6和维生素B12进行简单、廉价、无毒的治疗可降低血浆同型半胱氨酸水平。尽管同型半胱氨酸水平与心血管疾病之间的关联通常很强且在生物学上合理，但前瞻性研究的数据不太一致。此外，高同型半胱氨酸血症与心血管风险之间关联的流行病学观察并不能证明因果关系的存在。因此，叶酸、维生素B6和维生素B12在降低心血管发病率和死亡率方面的有效性需要在随机临床试验中进行严格测试。目前正在进行几项此类试验；鉴于维生素治疗的简单性和低成本，其结果可能会对心血管发病率和死亡率产生重大影响。
